What do Sigmund Freud, Mark Twain, Abraham Lincoln, comedian Joan Rivers and actor Rod Steiger all have in common? Besides notable achievement in their chosen fields of endeavor, these persons all suffered from depression.
According to statistics compiled by the National Mental Health Association (NMHA), some 17 million Americans suffer from some form of depressive illness or mood disorder. Depression’s cost to our economy has been estimated to be over $40 billion a year in absenteeism from work, lost productivity and direct treatment costs. Its outward signs are diverse, its causes still a bit mysterious. It strikes young and old, men and women, rich and poor. No demographic is immune.
Furthermore, its human toll is great. Psychiatrist Francis Mark Mondimore has written that depression “is a medical illness that causes lost productivity and time off from work at a tremendous dollar cost. It brings great misery: wasted days, months, and even years of impaired functioning at a human cost that cannot be measured. It is a disease with a frightening mortality rate. Its most serious complication, suicide, often takes its victims in the prime of life and is consistently one of the top 10 causes of death at all ages.”
But despite increased public awareness, one of the issues that most complicates depression is society’s fear and stigmatization of it. “Depression is much more common than people realize,” says Pamela T. Fishel-Ingram, Ph.D., assistant professor and director of program development at Vanderbilt University Medical Center’s Department of Psychiatry. “Unfortunately, many suffer in silence, and don’t seek treatment for a variety of reasons.”
Some typical depression symptoms that Fishel-Ingram cites include a persistent sadness, excessive crying, physiological changes involving sleep patterns or appetite, changes in concentration levels, a significant decrease in energy. Some patients describe a general sense of feeling “like you’re in a black hole.”
Discussions of mood usually include concepts such as “happy” and “sad,” but analysis goes further than this, also including sense of physical well-being, attitudes toward others, outlook toward the future, and personal esteem and confidence.
In general, mood disorders can be categorized thusly:
1) Clinical Depression—disorder of mood characterized by more acute, persistent episodes of feelings of despair, hopelessness, guilt, worthlessness; persistent physical symptoms that don’t respond to treatment; changes in activity regarding sleep, appetite or sex. (This form of depression is not to be confused with merely “having a bad day” or grief or bereavement, which are categorized as temporary states of mind.)
2) Dysthymia—a low-grade depression that can pervade a person’s thinking for many years.
3) Manic-Depression—more commonly called bipolar disorder nowadays, it includes severe depressive (low mood) episodes that are juxtaposed with bouts of elevated mood that can feature irritability, agitation and erratic behavior (e.g., spending sprees). A change in so-called vegetative functions is also seen (i.e., decreased need for sleep, appetite disturbance, increase in energy and hypersexual behavior).
Much of the mystery surrounding mood disorder stems from our lack of exact knowledge about its causes. Occasionally, people become depressed for no reason at all. On the other hand, there are many discernible trends and contributing factors that the medical community has focused on successfully:
1. Biological (i.e., brain chemistry);
2. Cognitive (chronic pessimists and people with low self-esteem are often likely to develop mood disorders);
3. Gender (women are twice as likely as men to suffer depression; possibly they’re simply reporting it more);
4. Co-Occurrence (depression can arise in conjunction with physical conditions or other mental illnesses);
5. Medication (antidepressants combined with other medications can prompt clinical depression);
6. Genetic factors (persons with a family history of mood disorder may have a higher predisposition for depression);
7. Situational (stress-inducing life events—divorce, finances, loss of a loved one—can contribute readily to depressed states of mind).
Other variations of mood disorders can affect the elderly, adolescents and children. There is seasonal affective disorder (SAD). There are panic attacks. Abusers of drugs and alcohol are at increased risk as well, for more obvious reasons. (They feel “low,” so they get “high.”)
If we don’t recognize ourselves in these profiles, we may very well recognize a relative or loved one. But one thing that has changed over the years where mental health of all kinds is concerned is treatment. Says Fishel-Ingram, “Ninety-nine percent of people are not 'crazy’.”
Thankfully, the days of lobotomy and high-level dosages of barbiturates to deal with the “mentally ill” are long gone. They have been replaced by an active psychotherapeutic and psychiatric medical community as well as major advances in drugs that have been proven to effectively balance “brain chemistry”—specifically, in the case of depression, to act on neurotransmitters, which convey messages from cell to cell throughout the central nervous system.
In the last decade or so, we have heard much of Prozac, Zoloft, Paxil, Wellbutrin and other drugs used to combat forms of depression; and in a well-medicated society such as ours, it’s worth noting that these medicines are not habit-forming. Like most medications, however, they have some side effects. Patients usually require up to eight weeks of a drug regimen before noticing an improvement in their lives. Dosages occasionally have to be adjusted. Most critically, persons taking antidepressants require monitoring by a doctor familiar with clinical depression in order to ensure the most efficacious treatment with the least physical reaction.
Equally important—and usually the first step to any kind of treatment—is psychotherapy. Some patients’ depressive episodes may not require the attention of drugs. “Talking therapy,” however, can offer patients coping skills via dialogue with a trained mental health professional. Such therapy has proven to be effective in treating depression that is less severe. The NMHA claims that various studies have shown that short-term courses of psychotherapy—approximately 10 to 20 weeks—can significantly reduce incidents of depression.
“It’s important to know what treatments are out there,” says Fishel-Ingram. “Patients need to have an awareness of their options at the outset.” Teamwork is the key, she says—a collaborative process among psychotherapists, psychiatrists (who are M.D.s with authority to prescribe medication) and internists, family physicians and primary care physicians (PCPs).
“Eighty percent of patients do best on a combination of psychotherapy and medication,” says Fishel-Ingram. “People can feel significantly different when treated.” (Only occasionally, in rarer cases, or when the risk of suicide is high, is electroconvulsive therapy [ECT] recommended for sufferers of depression. The NMHA states that “ECT is a safe and effective treatment that can save lives.”)
As with any disease or illness, combating depression takes courage. It’s important to see the strength in fighting it, rather than feel weak while simply enduring it. Fishel-Ingram endorses family focus as an extremely helpful step in removing shame.
She also offers recommendations for preventative measures—what the average person can do to combat mood disorder on a daily basis:
1) Exercise—always a good idea for general health, but in particular it cleans toxins from the body and raises epinephrine levels.
2) Diet—avoid high intake of carbohydrates, which can affect blood sugar and contain empty calories that can induce weight gain.
3) Sleep—maintain regular patterns.
4) Socialize—avoid isolation by finding a peer group to connect with (support groups, YMCA, social activity, etc.).
Fishel-Ingram is also a proponent of yoga and meditation, which offer good regimens of relaxation and concentration.
Like any other illness, depression needs to be taken seriously and requires professional treatment. As with any physical malady, wellness can begin with a trip to the family doctor. Alternatively, there are clinics specializing in mental health care. Some health insurance plans provide coverage for mood disorders. Alas, some do not, in which case it’s important to contact your health insurance administrator for details regarding treatment. For those over 65, Medicare now covers 50% of the costs of treatment. For the rest, the nearest publicly funded mental health center usually charges for services on a sliding-scale or sliding-fee basis, based on what you can afford.
But in the end, no price can be placed on enhanced self-esteem, a positive outlook on life and a productive work routine. All are the benefits of our nation’s further attention to, and awareness of, the debilitating effects of depression. Best of all is the knowledge that help is available.
